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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Floyd Michael Hood
MIDDLE CURRENT SURNAME
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSEl405_08_4573
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. NY B. Dutchess
(STATE) .L (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN U VILLAGE
~~CIFY Wappingers Falls
D. STREET ADDRESS 27 Prospect ~t. ZIP' Zb~U
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VIllAGE? '6 YES ~ NO
3. A. AGE 48 3B. DATE OF BiRTH 09 / 14 / 961
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Instructor
B. TYPE OF INDUSTRY OR BUSINESS Nuclear Power Plant
5. PLACE OF BIRTH Kenton, Kentucky
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Floyd Calvin Hood
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Geraldine Lou Hall
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARF,lIAGE 2
19. ~~~~~~~RMtFR~I{'&8us MARRIAGES WHICH ENDED BY
DE~TH D1~ORCE CIVIL A"tl'ULMENT
t<n .,
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT 2~01EATH B. HOW DID LAST MARRIAGE END? (3) 0 DIVOPfJ'7
C. DATE LAST MARRIAGE ENDED? 08 /07 / C. DATE LAST MARRIAGE ENDED?
MONTH ./JAY YEAR MONT
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE?
..
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE 'PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY, STATE/COUNTRY. IF NOT USA) SELF SPOUSE ~~lO;l"'p&,OYWII3) 0 (CITY/COU~ STATElfOUNIIlX,JF NOT USA) S,"F SPOUSE
o 0 1ST UflL;jIL UI range \,.,oumy, l'IIl 0 0
o 0 2ND 0 0
o 0 ~D 0 0
o 0 4TH 0 0
ge and belief that the Inlormatlon I provided Is true and that I declare that no legal Impediment xlsts
COUNTY Dutchess
CITYITOWN Wappinger
DISTRICT 1368 .
NUMBER
REGISTER 125
NUMBER
1. A. FULL NAME
FIRST
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
1ST
2ND
3RD
4TH
I duly swear/affirm, dep.ose and say
as to my right to enter Into the ma lag
21. SIGNATURE OF GROOM~
r
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Sharon Bernice Hernandez
--1
11. A. FULL NAME
CURRENT SURNAME
FIRST MIDDLE
B. BIRTH NAME (MAIDEN NAME), IF DIFFdENT Whitmore
c. SURNAME AFTER MARRIAGE Hoo
(OPTIONAL. SEE REVERSE>127 -50-4323
D. SOCIAL SIiClJ1l~ NUMBER
12. RESIDENCE A,N Y B. uutcness
(STATE) .L (COUNTY)
C. CHECK ~1' . 0 CITY D- TQWN 0 VILLAGE
~~~CIFY vvapplngers railS
2/ Prospect St.
D. STREET ADDRESS z,:::
E. IS RESleNCE WITHIN LIMITS OF CITY OR INCORPORA1D1 VIllAGE? 1-3 0 YEj )J.~O
13. A. AGE4 3B. DATE OF BIRTH L!.... ~
MONTH DAY YEAR
12590
14. EMPLOYMENT ..,
A. USUAL OCC,UPATIOr/lAdmlnlsyatlve
I
B. TYPE OF IND1TRY 0& BUS~SS
15. PLACE OF BIRTH uxe 0, ew YOrK
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER .
A. NAME Richard A. Stitt
. ,'U ti A
B. COUNTRY OF BIRTH
17. MOTHER Ad I'd B . Wh't
e al e ermce I more
A. MAIDEN NAME
B. COUNTRY OF BIRTHU ti ~
18. NUMBER OF THIS MARRIAGE
D~TH
.' ~ - YEAR
USEC
23. SUBSCRIBED AND SWORN TOIAFF 0 BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage In New York State 01 the bride and groom named above by any person authorized
Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o II checked, this license Is to be used only lor the purpose 01 a second or subsequent ceremony.
,-I'-.. 24. TOWN OR CITY C~ERK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) Jonn C. Masterson
{SEAL SIGNATURE ~ W!:.1r);J)~ DATE 11/06/2009 TIME MONTH YEAR MONTH
'-v-' ""~!Iif'dm.~~h Rd, Wappingers Falls, NY 12590 01:27: 11 07 2009. 01
STREfl crrvnowN STATE ~p
~~~R~~R::J 'o~O~~N~ZEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME M . Y YEAR 0 ~RELIGIOUS
DATE AND AT THE TIME AND -.flM"
PLACE INDICATED. ~ 0 0 PM 9 0 OTHER, SPECIFY
W
en
z
W
o
::J
29. OFFICIANT
NAME (PRINT)
YEAR
05 2010
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY :.J)u~~H
TITLE P...el/C('t!r\d.,
DATE /l1z.Pi' Iv 9
I
/lit
STATE
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ISCl"TOWN OF 0 VILLAGE OF
SPECIFY
U&'/f')4er
" - (.,001-
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE~